Provider Demographics
NPI:1578053013
Name:KUKIELSKI, MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KUKIELSKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 MIDWAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8485
Mailing Address - Country:US
Mailing Address - Phone:972-398-0393
Mailing Address - Fax:972-398-0499
Practice Address - Street 1:3108 MIDWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8485
Practice Address - Country:US
Practice Address - Phone:972-398-0393
Practice Address - Fax:972-398-0499
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant